SURGEON’S DIARY: The boy with appendicitis and   a ‘dad’ who was not his father

Saturday March 18 2017

I felt like saying that he should be told and

I felt like saying that he should be told and then I remembered what I had read in my medical journal which said that 10 per cent of fathers bring up children who don’t have their genetic imprint. ILLUSTRATION| JOHN NYAGAH 

“Every-body got what they wanted. I wanted my son. Isaac did not want to carry any luggage to the church when he got married.”

“I have Kevin here, with what looks like acute appendicitis.” It was Dr Lubia on the phone.” He is 12 and I suspect that his appendix might have perforated because he is very tender and guarded in his right iliac fossa.” He was referring to the right lower corner of the abdomen and continued: “Considering the emergency, I have sent him to the hospital and have instructed the Sister of the children’s ward to inform you when he arrives.”

I knew that Dr Lubia possessed sound clinical acumen and replied: “I am still in the hospital and will wait for Kevin. From what you say, he might need emergency surgery.” I looked at my watch. It was nearing six in the evening and I had just finished my consultations for the day. Considering the Nairobi traffic, I usually drive home before five or leave it till seven or later when the rush on the roads abates.

I read the latest surgical journal to usefully occupy my time while I waited but the memory of Alan Lubia’s time in my unit at the teaching hospital distracted me. He did his fifth year clinical term and surgical internship with me, when I noticed the surgical bent of his mind. I was impressed by the gentle pair of hands he possessed, manifested in his examination of patients and also how he handled tissues of patients under anaesthesia. Clinically, his fingers moved like feathers on the very tender bellies, without hurting the patients and, in the operating theatre, he exhibited great dexterity in his manoeuvres. So when he discussed his career with me during his internship, I said: “You have the making of a good surgeon and I suggest that you do post-graduate in surgery.”

“Thank you for the compliment,” he replied. “But it is a long course and very competitive now. I want to give my wife a decent home and my children a good education, which are not cheap. I simply haven’t got the time.”

LOOKED QUITE SERIOUS

“Pity,” I sighed. Since Dr Lubia looked quite serious and I wanted to lighten the atmosphere, I added: “I thought you could step into my shoes when I retire. On a serious note, we need good surgeons to treat us when we need surgery and also we want to leave a good legacy when we go.”

“I think I will go into general practice because I don’t need an additional classification for it,” Dr Lubia replied. “And there are busy GPs who are looking for an associate or a partner.”

This is precisely what he did. After finishing his internship in medicine and surgery, he did six months in paediatrics and obstetrics respectively to gain experience in children’s diseases and midwifery and joined a busy family practice. As it happened, his principal developed a fatal heart attack and it all fell in his lap, making him one of the busiest GPs in town. Because of the past association, he referred all his surgical work to me and Kevin was the latest. My reverie was disturbed by a phone call from the children’s ward. “Kevin has arrived,” Sister said. “His father tells me that Dr Lubia rang you and you are expecting him. Kevin is in a lot of pain. Shall I give him a sedative?” she asked. She meant a pain-killer.

“No,” I replied. “It will mask the symptoms. In any case, I am in the hospital and will be with you in five minutes. Once I have seen him, it is very likely that Kevin will need to go to the theatre. I have alerted the theatre and my anaesthetist. Luckily they both are available.”   

I walked to the children’s ward, examined Kevin and came to the same conclusion as Dr Lubia. As I was leaving for the theatre, just outside the ward, I was met by Kevin’s father. “How is my son?” he asked.

“As Dr Lubia must have told you, Kevin suffers from acute appendicitis and that appendix needs to come out – mara moja,” I replied.

“Is there any danger?” he expressed his concern.

“Not really,” I said. “But even if there was, we don’t have any choice. That appendix is better out of his belly and the sooner it is done the better.”

“I am very worried,” he replied. “I hope you don’t mind if I sit outside the operating theatre while you operate on my son and see you again after surgery.”

“Please yourself,” I said. “Usually appendicectomy is a straight forward operation and there is not much to worry about.”

At operation, I was pleased to see that though the appendix was grossly swollen and looked like a small sausage filled with pus, it had not burst, a fact which would make Kevin’s post-operative course very smooth and shorten his stay. As expected, Kevin’s father was waiting for me outside the theatre.

“I better introduce myself properly,” he started: “As you know, I am Kevin’s dad and my name is Justus.” I gave him the details and subsequently, he saw me every day, inquiring about the progress his son was making, anxiety and concern etched on his face.

DEVOTED DAD

Next morning when I went to see Kevin, Sister informed me: “Kevin’s mother came to see him last night just before I left. She had been informed about him by her husband. Apparently they have been parted for a few years.” I filed the information in the remote recesses of my mind as a piece of social history of my patient, which had no bearing on the surgical aspect of the case. It remained there until the day Kevin was discharged from the hospital and Justus came to see me, ostensibly to thank me but, as became apparent, to ask me a lot of questions about his son. After a prolonged interrogative session, I complimented Justus on what a devoted dad he was.

“I wish that all fathers of my paediatric patients were like you. Medical research has shown that loving parents produce stable children and create a society which is free of juvenile delinquency.” I then remembered what Sister had told me about the breakdown of Justus’ marriage and modified my compliment. “In our society, children are mainly the responsibility of mothers so Kevin is lucky to have a model father like you.”

That is when Justus dropped the bombshell after taking a little time deciding whether I should be privy to his secret. “I am not Kevin’s real father.”

“What!” I shot out of my chair. “Kevin’s hospital file and my office have mentioned you as Kevin’s dad.”

“Let me correct myself,” Justus said very calmly. “I am not his biological father.” I found his unruffled demeanour a bit disconcerting but suffered it in silence because I could see that he wanted to say more. “It happened like this. Irina and I met in a business school where she was doing an IT course and I was pursuing accountancy. She was attractive and was going round with a bloke. I had an eye on her and eventually unhooked her from Isaac and married her after we finished our training. Kevin was born a year later and I doted on him.” Justus took a pause as the happy smile on his face vanished. “Soon after, cracks started appearing in our relationship. Irina and I were constantly arguing, mainly about Kevin. Once when he was four, we got into a hot argument about his schooling and I said: “Surely I have a say in my son’s education.” Irina lost her cool and blurted out: ‘Kevin is not your son.’ My whole world crashed that moment and all I could do was to ask ‘Whose son is he?’” It turned out that though I thought I had snatched Irina from Isaac, their association continued until Isaac found a girlfriend, who ultimately became his wife.”

“Is there a DNA proof?” I asked when I found my tongue.

“Yes,” replied Justus. “I insisted on it and Irina was proved right. Isaac is Kevin’s biological father.”

“So what did you do?” I had recovered from my shocked state.

“Irina and I eventually parted. In the divorce settlement, I insisted that I got full irrevocable custody of Kevin,” Justus explained.” After all I had brought up Kevin as my own son.

“I had laughed with him and had occasionally cried for him. You can’t forget that simply because he is not conceived with your sperm.” There were tears glistening in his eyes as he emphatically and with deep emotions continued: “I have seen parents showering their adopted children with more love than some biological parents do.”

 “What about Irina and Isaac?” I asked. “After all they are important people in this unfortunate triangle.”

“Unfortunate it might be,” replied Justus. “But it is a happy one. Everybody got what they wanted. I wanted my son. Isaac did not want to carry any luggage to the church when he got married.” Justus was good humoured for the first time since I had met him. Offloading his secret to somebody whose lips were sealed by his vocation had freed him emotionally. “He wanted to start on a clean slate and did not want any connection with his past. Irina did not want to bring up Kevin as a single parent. Her chances of getting remarried are better if she is free of encumbrances. She asked for visiting rights and has them.”

“Does Kevin know all this?” It was my final question.

“Not all,” Justus replied. “He knows about Irina and my divorce.”

I felt like saying that he should be told and then I remembered what I had read in my medical journal which said that 10 per cent of fathers bring up children who don’t have their genetic imprint.